Sometimes long term care can start to wane on you as a therapist. The longer you work in a building the higher the likelihood that you have worked with every resident in your building. Often times, you have seen them multiple times in the past. Unfortunately this is how an unexpected decline happens.
Declines can happen gradually without warning
When we fall into the rut of seeing the same person again, we don’t often realize how much could have easily changed without us realizing. It’s like the lobster in the pot of cold water that begins to boil and before long it is cooked.
Too long of brainwashing from insurance companies
The managed care insurance world loves it when therapists get into that rut. They don’t need to pay for services if we don’t perform these services. They much prefer to accept the monthly payment from Medicare to “cover” these residents. It is forgotten that maintaining quality of life, or preventing a decline is a Medicare covered service. Since it is covered by Medicare, the Medicare Advantage plans need to cover it as well.
Too many years of focus on Short term Rehab
Our focus for years on short term rehabilitation patients and the consistent rotation of residents also has skewed our thinking and understanding of what services we can provide.
Because of the nature of short term rehab we set goals based on prior level of function and work towards regaining that function. We work from a decline in function to improve function. There is the idea of making progress.
Long term care requires a change in thinking
With the changing world of skilled nursing and long term care, we need to change our mentality to focus on maintaining function or preventing declines.
As CMS changes the way they monitor and report the quality of a nursing home, we need to change also. As CMS uses quality measures to grade a nursing home, we need to be preventing declines instead of fixing declines.
The quality measures report on preventable declines in resident health. These measures include things like needing more assistance with bathing and dressing, decreased ability to walk, increased incontinence, and new wounds.
Therapy intervention to prevent or maintain
This is where we need to change our way of thinking. We need to focus on being preventative medicine and assisting in maintaining current functional levels. By changing that focus we actually truely begin to address quality of life
If our bouts of therapy services help to keep someone from needing more assistance, staying more independent, and maintaining a quality of life, then we will directly impact the quality measures of the facility.
For years outside the Nursing home walls we have been pushing further and further into prevention. Medicare advises beneficiaries to see a physical therapist upon enrollment for a falls prevention screening. There are even more and more states allowing more Physical Therapists to act as a primary care provider for any musculoskeletal issues. Most states also allow for direct access to the therapists without the need for a prescription.
It’s time to allow those ideas into the SNF world
So now is the time to look at what we do with new “open eyes”. We need to take credit for our skills that we have developed over years of practicing. We need to give our residents a fresh new perspective and give them the chance to age appropriately and maintain quality of life. So go out there tomorrow and help at least one person maintain their quality of life. Flip the script and prevent disease and disability. Make a difference.
